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QOF screening for depression will swamp practices

Screening for depression under the QOF is set to swamp practices with patients for whom there is limited evidence of effective treatment, new research suggests.

A meta-analysis of more than 50,000 people from Europe and the US found a 60 per cent increased risk of depression in patients with diabetes over the general population.

But the researchers warned this week's Diabetes UK Con-

ference that a lack of well-

controlled studies meant it was unclear how best to treat patients detected by screening.

Study author Dr Margaret Stone, a research fellow at the department of health sciences at the University of Leicester, said: 'One of the problems is that we have a poor understanding of whether depression is a risk factor for diabetes or whether diabetes is a risk factor for depression. Until we understand this link it's difficult to know the best way to treat these patients.'

GPs predicted the task of screening all CHD and diabetes patients for depression and assessing severity ­ together worth up to 33 QOF points from 1 April ­ would lead to a surge of cases putting even more pressure on overstretched services.

Dr John Pittard, a member of the Primary Care Cardiovascular Society and a GP in Staines, Middlesex, said lack of treatment availability was also a concern in heart disease patients.

'We will end up with another unmet need in the NHS and it has not been fully evaluated if it's worth meeting. Generally what happens is because there are no services you give out antidepressants,' he said.

Dr Robert Morley, executive secretary of Birmingham LMC, said: 'Every practice will be diagnosing hundreds of new cases and prescribing will go through the roof as we're unable to refer them to non-existent cognitive behavioural therapy services.'

But GPC deputy chair Dr Laurence Buckman insisted that experts had found the evidence base for depression screening was strong enough: 'The mental health experts have evidence that treatment works.

'The evidence for diabetes and heart disease is that they tend to do better with pills, but it's not clear which,' he said.

The meta-analysis was based on 10 studies that screened patients with and without diabetes using self-report tools or diagnostic interviews.